Pharmacy Network Audit Analyst

at  Pharmacy Data Management Inc

PDMI is looking to add a Pharmacy Network Audit Analyst to our team! Since 1984, PDMI has provided pharmacy data processing and other flexible, scalable solutions to help our clients meet their business objectives. We offer transparent, pass-through pharmacy processing and other services for private label Pharmacy Benefit Managers (PBMs), vertically integrated health plans and hospital systems. In addition to Pharmacy Benefit Administrative Services, we offer 340B Administration, Hospice and Long-Term Care Services.

YOUR ROLE:

As a Pharmacy Network Audit Analyst, you will be at the heart of our pharmacy network operations, ensuring the accuracy and quality of audits from start to finish. This role involves coordinating and executing detailed audits, identifying potential Fraud, Waste, and Abuse (FWA), and supporting both client services and pharmacy networks. You will play a key role in maintaining high standards in quality assurance, data analysis, and operational reporting, making a tangible impact on our operations and client satisfaction.

KEY RESPONSIBILITIES:

• Audit Leadership: Take charge of tracking, monitoring, and managing pharmacy and claim audits, ensuring a seamless process from initiation to completion.
• Client and Pharmacy Liaison: Act as the primary contact for clients and pharmacies regarding audit procedures, ensuring clear communication and resolution.
• Data-Driven Insights: Compile and analyze data to identify potential FWA, and provide actionable insights to prevent future occurrences.
• Quality Assurance: Develop and implement quality assurance standards that exceed industry best practices.
• Policy Development: Create and publish policies and procedures for all aspects of pharmacy network audits.
• Operational Excellence: Assist in the maintenance and update of pharmacy network information and contribute to the enhancement of MAC operations.